OECD Reviews of Health Care Quality

These reviews examine the quality of health care in various countries, highlight best practices, and provide a series of targeted assessments and recommendations for further improvements to quality of care in the subject country.

At a time when ever more information is available about the quality of health care, the challenge for policy makers is to better understand the policies and approaches that sit behind the numbers. Korea is the first country report in a new OECD series evaluating the quality of health care across OECD countries – whether care is safe, effective and responsive to patients’ needs. OECD Reviews of Health Care Quality examine what works and what does not work, both to benchmark the efforts of countries and to provide advice on reforms to improve quality of health care. This series of individual country reviews will be followed by a final summary report on the lessons learnt for good policy practices.

This report is the first of a new series of publications reviewing the quality of health care across selected OECD countries. As health costs continue to climb, policy makers increasingly face the challenge of ensuring that substantial spending on health is delivering value for money. At the same time, concerns about patients occasionally receiving poor quality health care have led to demands for greater transparency and accountability. Despite this, there is still considerable uncertainty over which policies work best in delivering health care that is safe, effective and provides a good patient experience, and which quality-improvement strategies can help deliver the best care at the least cost. OECD Reviews of Health Care Quality seek to highlight and support the development of better policies to improve quality in health care, to help ensure that the substantial resources devoted to health are being used effectively in supporting people to live healthier lives.

This report reviews the quality of health care in the Korean health system. It begins by providing an overview of the range of policies and practices and the role they play in supporting quality of care in Korea today (Chapter 1). It then focuses on three key areas: using health financing to drive improvements in the quality of health care (Chapter 2), strengthening primary care in Korea (Chapter 3), and improving care for cardiovascular diseases (Chapter 4). In examining these areas, this report seeks to highlight best practices and provide recommendations to improve the quality of health care in Korea.

Korea has undergone a remarkable increase in economic and human development over the past three decades. Rising standards of living have been accompanied by major improvements in the availability of health care services, underpinned by the rapid expansion of health insurance coverage. Remarkably, Korea today combines one of the highest life expectancies in the world with one of the lowest levels of health care expenditure amongst OECD countries (6.9% of GDP in 2009). Hospitals are more likely to be available, and equipped with cutting-edge medical technologies, than in most other OECD countries. Two decades of pursuing reform has not only expanded coverage but also delivered administrative savings through the consolidation of insurers under the publically-owned National Health Insurance Corporation. The development of the Korean health system over the past two decades serves as a model for countries seeking to deliver universal coverage for health care through social insurance at a reasonable cost.

This chapter provides an overview of policies and strategies to improve the quality of care in the Korean health system. It seeks to describe key quality of care policies and benchmark the extent to which Korea has deployed various policies that are commonly used across OECD countries to assure the delivery of high quality health care. In doing so, it is broadly based on a framework that categorises policies according to those that are system wide, which assure inputs into health care, which monitor the quality of services delivered and which promote continuing improvements in quality. As a health care system characterised by a heavy reliance on private provision of services and a significant acute care sector, quality of care policies in Korea are more often driven by pockets of motivated individuals or institutions. Efforts to build in system-wide policies are often still under development, and in some cases could benefit from additional support or regulation to encourage their adoption.

This chapter examines the financing and organisation of the Korean health care system and whether it is driving improvements in the quality of care. Korea’s national health insurance faces a difficult budgetary environment as it grapples with rapidly rising health care costs, in large part driven by a very competitive hospital sector that is underpinned by fee-for-service financing rewarding the over-supply of medical services. It is argued that Korea ought to use its single insurer to more explicitly drive quality across the health care system. This should begin by shifting to financing hospitals through diagnostic-related groups (DRGs) to reduce the over-provision of services per patient. More broadly, stronger budgetary controls on hospital expenditure should be used to shift the balance of funding towards primary care over time. In this context, Korea’s unique pay for performance programme has demonstrated the capacity to extract valuable information to assess the quality of care. Future reform should seek to build on this by incorporating assessments of quality of care into financing.

This chapter highlights why bolstering primary care ought to be a major priority for Korea in the years ahead. Korea has one of the world’s most rapidly ageing populations and rising chronic diseases. This is already a major challenge to the health system, as illustrated by high levels of potentially avoidable hospital admissions for key chronic diseases and increasing expenditure on chronic disease-related care. At the same time, the absence of functional gate-keeping and the large number of clinics seeking to provide more "acute" services often leads to patients missing out on less technology intensive but highly cost effective patient counselling to prevent and manage their health condition. To improve the quality of care in the Korean health system, policy makers should support the growth of effective primary care services in communities. Not only will this require more primary care practices and better remuneration for family medicine, but it will also require the development of a regional architecture so that insurance can target funding to areas of need. Collecting better information and bolstering the workforce of primary care professionals are two fundamental reforms that will be needed to help develop better primary health care in Korea.

This chapter reviews the quality of care for cardio and cerebrovascular diseases in Korea. Quality of care indicators suggest an interesting paradox in patient outcomes in Korea, where outcomes for two conditions where countries are generally either relatively good or relatively bad – AMI and stroke – tend to diverge in Korea. In seeking to unpack this paradox, and the extent to which it is influenced by the health care system and health policies, it is argued that acute care is usually delivering high quality cardiovascular care, though variations in quality exist across the country. Consistent with recommendations for improvement across the health system, the focus of efforts to improve quality of care should be prior to and after hospital admission. In particular, preventing cardiovascular disease, supporting patients in managing their health in primary care and improving ambulance services are worthwhile reforms. Similarly, establishing formal rehabilitation processes for AMI and stroke would also be a high value for money investment in Korea.